Abstract
“You get mixed messages because I have mixed feelings.”
A
First among these is the Pew Foundation survey of public opinions concerning life extension. 1 Note first that, most unfortunately, it was very firmly articulated in terms of life extension, obscuring the absolutely critical fact that any longevity benefits from medical postponement of aging will occur, if at all, only as a side-benefit of postponing age-related ill-health. I strongly believe, based on my own quite extensive interaction with people from all walks of life who (for example) attend my talks, that the “Tithonus error” (that postponing aging would extend ill-health rather than health span) underpins most of the public's ambivalence concerning our field, despite gerontologists' vocal attempts to correct it. But be that as it may, the facts are these: Fully 56% of the US public are unenthusiastic about living longer.
How can this be? Maybe it's mostly the Tithonus error, but I must not overstate that case: In my experience, even those who are disabused of that misconception are uncannily prone to fall back on some other objection to such work (whether it be overpopulation, boredom, immortal dictators, whatever). Thus, and especially in societies such as the United States, in which money plays such a part in determining people's priorities, it is of utmost importance to highlight the benefits to society that any, even quite modest, postponement of age-related ill-health would deliver, since the economic benefits are among the most unarguable and least appreciated. In this context it is therefore my pleasure to draw your attention to the recent study by Goldman and colleagues, which highlighted more starkly than ever a truth that gerontologists have been impressing on policy-makers for decades: That postponing aging by even a few years would save society an astronomical amount of money. 2
The operative word in the preceding paragraph, in case it wasn't clear, is “decades.” How in hell can public attitudes in the United States be so negative about our work if its economic benefit is so huge and has been touted as so huge for so long? And since they are, what are the realistic chances that this new study, or the next one, or the one after that, will succeed when prior attempts have failed?
The answer is painfully obvious: That the benefits in question would only arise from success in developing medicines that postpone aging, whereas the required (and requested) investment is in research, which, by definition, may or may not deliver such success within a given time frame. Thus, political will to support biogerontology research depends utterly on decision-makers' perception of how likely it is that this research will succeed. If that perception is essentially that the chance of success is nil, no amount of quantitation of benefit helps: Zero times anything is still zero.
And that brings me to the third recent news of relevance to this topic. On October 30th and 31st, the National Institutes of Health (NIH) hosted a conference focused squarely on the promise of aging research to deliver postponement of the diseases of old age. 3 The event occurred under the auspices of the Geroscience Interest Group (GSIG), a body set up by the head of the National Institute on Aging (NIA)'s Division of Aging Biology to improve communication between the NIA and the numerous institutes whose focus is largely on one or another disease of old age. The purpose of that communication, of course, is to educate disease-specific communities (and funders) concerning the relevance of aging research to their topic of interest. But that relevance arises solely from the assumption that aging research will translate into therapies (most probably preventative ones) for said diseases—and will, with respectable probability, do so on a timescale comparable with the research that those institutes are already funding.
So, was the conference a success? Ostensibly yes: It attracted top-flight speakers, and the attendee list included many high-level representatives of the NIH institutes that constitute the core audience for this message. Moreover, NIH Director Francis Collins graced the meeting with his presence and delivered the opening talk. But under the hood, things look rather less rosy. The non-governmental big fish in US medical research funding were almost entirely absent, and disease-specific researchers were also thin on the ground: Speakers were mostly drawn from the ranks of card-carrying biogerontologists. All in all, there seems to be an air of considerable caution, at best, surrounding this potentially seminal initiative.
Why? A peek somewhat further under the hood offers a depressingly clear answer. Hallway discussions with key figures revealed two key facts that you will not find stated publicly: First, that Dr. Collins is not yet ready to take the GSIG concept higher (to his overlords in government)—an absolute prerequisite for the securing of a hike in the overall NIH budget to support GSIG-inspired research—and second, that it has already been accepted that without such a hike the GSIG will not progress meaningfully from being a mere talking shop, for the unsurprising reason that the alternative is redistribution of non-NIA NIH funds from disease-specific areas into more biogerontological ones, a policy that would, obviously, be energetically resisted by the recipients of disease-specific money and their NIH champions.
So, what would it take to induce Dr. Collins—whose own research area, let's not forget, is progeria—to fight for the GSIG concept in the corridors of power? I have not talked to him myself, so all I can offer is my own guess, but it's a pretty confident guess. He will fight that battle only when he thinks he can win it, or at least induce his key contacts (Health and Human Services Secretary Kathleen Sebelius, in particular) to take it the next step. And that will only happen when there is a perception of shifting political will concerning the whole idea of medical intervention against aging, which in turn requires a shift in perceived public opinion away from what is illustrated by the Pew survey.
So, what might precipitate such a shift? Evidently not entreaties around desirability, as the consistent failure of economics-based arguments demonstrates. No: It's all about feasibility—and in particular, feasibility within a defined time frame. If you doubt this, just think back 40 years to the “war on cancer”—a shining example of political will delivering a large rise in funding for a specific area. It occurred solely because leading cancer researchers were willing to state publicly that decisive progress was likely to occur within a decade if only suitable funding was forthcoming. Note further that there has been absolutely no sign of any loss of public enthusiasm or political will for cancer research, in spite of the huge disparity between the predicted and actual rate of progress in anti-cancer research in recent decades.
So, who determines public perception of whether aging research can deliver therapeutic benefit any time soon? As with all technical fields, the people with the greatest power are those few scientists who have risen to true “opinion-former” status in the media: Neil de Grasse Tyson, Bill Nye, Brian Cox. So, who determines what they think and are willing to say on camera? Naturally, it's the domain experts—those with the credentials to command the attention of generalist scientists who know what they don't know. In other words, in this case, the biogerontologist mainstream—the very people who would financially benefit the most from this chain of events.
Sweet, no? According to the above, all we now need to bring about sharply increased funding for biogerontology research is for the prospective recipients of that funding to offer, publicly, an estimate—a hugely speculative estimate would be perfectly sufficient—of the anticipated time frame for converting biogerontology research into interventions that would make the multi-decade difference to the age of onset of age-related disease that many such researchers are already happy to bandy about in a time frame–free manner. How distasteful is that?
Apparently, unacceptably distasteful. Sierra first floated the GSIG concept at a small, invitation-only meeting in early 2010, and this same issue was raised then (not by me, in fact); but the consensus was overwhelmingly that principled researchers cannot stoop to discussing time frames, because research is intrinsically so unpredictable. Similarly, at the first SENS conference (back in 2003) I gave a talk entitled “Biogerontologists' duty to discuss time frames publicly” 4 and encountered a thoroughly lukewarm (at best) reception from senior biogerontologists. At the GSIG conference, there was an unabashed expression of that same stance.
It might be considered laudable that biogerontology researchers are willing to sacrifice their own funding in favor of this principle, and reprehensible that cancer researchers were so breathless back in the 1970s (and since—let's not forget that the National Cancer Institute [NCI] director renewed that prediction not long ago). But it isn't. In practice, researchers do make estimates of probabilities of success all the time—in choosing what projects to work on, in evaluating each other's work during peer review, etc. So the issue here is actually not the assessment itself, but the publicizing of the assessment. Researchers in aging are acutely aware of the intense hope with which their work is followed by the wider world, and are paralyzed by fear of over-selling and under-delivering, which (they presume) would result in their being painted as no better than the purveyors of miracle anti-aging cures of time immemorial.
To me, it is that attitude which is reprehensible. Whether or not it is true (which I anyway doubt, given the cancer precedent outlined above) that the loss of reputation arising from such over-selling (if it turned out so to be) would be so awful as to outweigh the funding considerations, that dilemma is between two purely selfish motives—money now and notoriety-driven shortage of money later, or less money now but reputation untarnished. What my colleagues should, in fact, be asking themselves is how they can best repay society for its decision to give them their chosen life of freedom from the private-sector rat race. (I will not digress into whether the academic rat race is any better.) I submit that the answer is clear: Researchers should say what they actually think. At present, it is customary for researchers to dangle the carrot of success in our research without mentioning time frames, thus conveniently protecting themselves from any chance of being seen as overoptimistic, but also failing to engender the public enthusiasm so vital for allowing the necessary research to actually happen. This cannot be allowed to continue.